<%@ page language="java" contentType="text/html; charset=utf-8"
	pageEncoding="utf-8"%>
<%@include file="./header.jsp" %>
<head>
	 <link rel="stylesheet" href="./styles/luanbo/themes/default/default.css" type="text/css" media="screen" />
	<link rel="stylesheet" href="./styles/luanbo/nivo-slider.css" type="text/css" media="screen" charset="utf-8"/>
	<script src="./js/luanbo/jquery.nivo.slider.js"></script>
	<style>
		.order-form label{
			font-weight: normal !important;
		}
		
		.help-block{
			font-size: 12px;
			color: #989898;
		}
	</style>
</head>

<body>
	<tags:top/>
    <div class="container">
    	<div class="row" style="margin-top:20px;">
    		<div class="col-sm-9 col-md-9">
    			<h3 style="font-weight: bold;">提交订单</h3>
    			
    			<div style="background: #ECECEC;padding: 5px;"></div>
    			<form class="form-horizontal order-form" role="form">
   					<div class="form-group">
					    <label for="inputEmail3" class="col-sm-3 col-md-2 control-label">商品名称：</label>
					    <div class="col-sm-8 col-md-6 col-md-6">
					      	<p class="form-control-static" style="font-weight: bold;">放大镜卡经费端口</p>
					    </div>
					  </div>
					  
					  <div style="font-weight: bold;padding:20px 0px;font-size:16px;">快递信息</div>
					  <div class="form-group">
					    <label for="inputEmail3" class="col-sm-3 col-md-2 control-label">收件人：</label>
					    <div class="col-sm-8 col-md-6">
					      <input type="email" class="form-control" id="inputEmail3">
					      <span class="help-block">收件人请与有效证件姓名保持一致，便于收取物品</span>
					    </div>
					    
					  </div>
					  
					  
					  <div class="form-group">
					    <label for="inputPassword3" class="col-sm-3 col-md-2 control-label">手机号码：</label>
					    <div class="col-sm-9 col-md-6">
					     <div class="col-sm-7" style="padding-left:0px;">
						  	<input type="text" class="form-control" id="inputPassword3">
						  	<span class="help-block" style="display: block;margin-top:5px;">手机号码是我们联系您最重要的方式</span>
						  </div>
						  
						 <div class="col-sm-5" style="padding-left:0px;">
						 	<button type="submit" class="btn btn-primary">发送验证码</button>
						 </div>
					     
					    </div>
					     
					  </div>
					  
					  <div class="form-group">
					    <label for="inputPassword3" class="col-sm-3 col-md-2 control-label">验证码：</label>
					    <div class="col-sm-8 col-md-3">
					      <input type="text" class="form-control" id="inputPassword3">
					       <span class="help-block">收不到验证码请联系我们的客服</span>
					    </div>
					  </div>
					  
					  <div class="form-group">
					    <label for="inputPassword3" class="col-sm-3 col-md-2 control-label">所在地区：</label>
					   
					    <div class="col-sm-8 col-md-6">
						  <div class="col-xs-4 col-sm-4" style="padding-left:0px;">
						  	<select class="form-control">
						  		<option value="">请选择</option>
						  	</select>
						  </div>
						  <div class="col-xs-4 col-sm-4"  style="padding-left:0px;">
						    <select class="form-control">
						  		<option value="">请选择</option>
						  	</select>
						  </div>
						  <div class="col-xs-4 col-sm-4" style="padding-left:0px;">
						    <select class="form-control">
						  		<option value="">请选择</option>
						  	</select>
						  </div>
						</div>
					  </div>
					  
					  <div class="form-group">
					    <label for="inputPassword3" class="col-sm-3 col-md-2 control-label">街道地址：</label>
					    <div class="col-sm-8 col-md-6">
					      	<textarea rows="" cols="" class="form-control"></textarea>
  						    <span class="help-block">不需要重复填写省市区，如地址错误请联系客服</span>
					    </div>
					  </div>
					  
					  <div style="font-weight: bold;padding:20px 0px;font-size:16px;">附加信息</div>
					  
					   <div class="form-group">
					    <label for="inputPassword3" class="col-sm-3 col-md-2 control-label">附言：</label>
					    <div class="col-sm-8 col-md-6">
					      	<textarea rows="" cols="" class="form-control"></textarea>
					    </div>
					  </div>
					  
					  <div class="form-group">
					    <div class="col-sm-offset-3 col-md-offset-2 col-sm-8 col-md-6">
					      <button type="submit" class="btn btn-danger">提交订单</button>
					    </div>
					  </div>
				</form>
    		</div>
    		
    		<div class="col-sm-3 col-md-3">
    			aaa
    		</div>
    	</div>
  	</div>
	
	<tags:bottom/>
	<script>
		$(function(){
			
		});
	</script>
	
</body>